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Consecutive cataract surgery in patients with PKP

Poster Details

First Author: P.Vassileva BULGARIA

Co Author(s):    Y. Kirilova                    

Abstract Details


Cataract surgery in patients with corneal diseases causes serious problems. It is a common co morbidity and risk of cataract development or progression after PKP increases significantly, especially in patients above 50 years of age, regardless of primary corneal pathology. Cataract formation is an ageing process and also a common complication of PKP. It may be the result of same underlying pathology, prolonged use of corticosteroid agents to prevent rejection as well as due to lens trauma during transplantation surgery. Our purpose is to evaluate the challenges of cataract surgery in patients with PKP.


Referral University eye hospital, Sofia, Bulgaria


We present our surgical approach on all consecutive phakic patients with PKP operated for the period of 9 years (Jan 2007- Dec 2016) with follow up of 15 months to 9 years. Corneal transplantation was performed by standard surgical technique with vacuum trephines for PKP was performed with suture removal in 24 +/- 2 months. We applied different surgical approach depending on lens status during PKP surgery: combined/triple procedure or consecutive surgery for cataract.


Altogether 187 phakic patients, mean age 47 (range 18-64). Indication for PKP: keratoconus n=75 (40%), corneal dystrophies n=48 (26%), leucoma n=37 (20%), graft failure n=11 (6%), corneal perforation n=7 (4%), pellucid degeneration n=4 (2%), corneal abscess n=4 (2%). Cataract was diagnosed duringt PKP in 24 patients (13%). In 19 patients open sky cataract surgery was undertaken after trephination. Formation/progression of cataract post PKP was diagnosed in 65 patients (35%). Phacoemulsification in early postoperative period (before suture removal) was done in 7 patients (4%). Planned phaco 3 months after suture removal was performed in 51 patients (27%).


Considerable debate consists on surgical approach in patients with PKP associated with lens opacities. Stage of lens opacities in patients indicated for PKP cannot always be assessed preoperatively. There are strong arguments for triple procedure even for initial cataract at PKP mostly for older patients. Consecutive phacoemulsification post suture removal assures more accurate IOL calculation and better visual results. Our experience demonstrated excellent outcome after consecutive phacoemulsification in patients with cataract post corneal transplantation. Customized surgical technique and endothelial protection assure full restoration of vision.

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